First Aid for Soldiers FM 21-11

FM 21-11 First Aid for Soldiers: Appendix B

Rescue and Transportation Procedures

Headquarters, Department of the Army, Washington, D.C., October 27, 1988

B-1. General

A basic principle of first aid is to treat the casualty before moving him. However, adverse situations or
conditions may jeopardize the lives of both the rescuer and the casualty if this is done. It may be
necessary first to rescue the casualty before first aid can be effectively or safely given. The life and/or
the well-being of the casualty will depend as much upon the manner in which he is rescued and
transported as it will upon the treatment he receives. Rescue actions must be done quickly and safely.
Careless or rough handling of the casualty during rescue operations can aggravate his injuries and
possibly cause death.

B-2. Principles of Rescue Operations

a. When faced with the necessity of rescuing a casualty who is threatened by hostile action, fire, water,
or any other immediate hazard, DO NOT take action without first determining the extent of the hazard
and your ability to handle the situation. DO NOT become a casualty.

b. The rescuer must evaluate the situation and analyze the factors involved. This evaluation involves
three major steps:

 Identify the task.

 Evaluate circumstances of the rescue.
 Plan the action.

B-3. Task (Rescue) Identification

First determine if a rescue attempt is actually needed. It is a waste of time, equipment, and personnel to
rescue someone not in need of rescuing. It is also a waste to look for someone who is not lost or
needlessly risk the lives of the rescuer(s). In planning a rescue, attempt to obtain the following
information:

 Who, what, where, when, why, and how the situation happened?
 How many casualties are involved and the nature of their injuries?
 What is the tactical situation?
 What are the terrain features and the location of the casualties?
 Will there be adequate assistance available to aid in the rescue/evacuation?
 Can treatment be provided at the scene, will the casualties require movement to a safer
location?
 What equipment will be required for the rescue operation?
 Will decon procedures and equipment be required for casualties, rescue personnel and rescue
 equipment?

B-4. Circumstances of the Rescue

a. After identifying the job (task) required, you must relate to the circumstances under which you must
work. Do you need additional people, security, medical, or special rescue equipment? Are there
circumstances such as mountain rescue or aircraft accidents that may require specialized skills? What is
the weather like? Is the terrain hazardous? How much time is available?

b. The time element will sometimes cause a rescuer to compromise planning stages and/or treatment
which can be given. A realistic estimate of time available must be made as quickly as possible to
determine action time remaining. The key elements are the casualty's condition and the environment.

c. Mass casualties are to be expected on the modern battlefield. All problems or complexities of rescue
are now multiplied by the number of casualties encountered. In this case, time becomes the critical
element.

B-5. Plan of Action

a. The casualty's ability to endure is of primary importance in estimating the time available. Age and
physical condition will differ from casualty to casualty. Therefore, to determine the time available, you
will have to consider--

 Endurance time of the casualty.

 Type of situation.
 Personnel and/or equipment availability.
 Weather.
 Terrain.

b. In respect to terrain, you must consider altitude and visibility. In some cases, the casualty may be of
assistance because he knows more about the particular terrain or situation than you do. Maximum use
of secure/reliable trails or roads is essential.

c. When taking weather into account, ensure that blankets and/or rain gear are available. Even a mild
rain can complicate a normally simple rescue. In high altitudes and/or extreme cold and gusting winds,
the time available is critically shortened.

d. High altitudes and gusting winds minimize the ability of fixed-wing or rotary wing aircraft to assist in
operations. Rotary wing aircraft may be available to remove casualties from cliffs or inaccessible sites.
These same aircraft can also transport the casualties to a medical treatment facility in a comparatively
short time. Aircraft, though vital elements of search, rescue or evacuation, cannot be used in all
situations. For this reason, do not rely entirely on their presence. Reliance on aircraft or specialized
equipment is a poor substitute for careful planning.

B-6. Mass Casualties

In situations where there are multiple casualties, an orderly rescue may involve some additional
planning. To facilitate a mass casualty rescue or evacuation, recognize separate stages.

 First Stage. Remove those personnel who are not trapped among debris or who can be
evacuated easily.
 Second Stage. Remove those personnel who may be trapped by debris but require only the
 equipment on hand and a minimum amount of time.
 Third Stage. Remove the remaining personnel who are trapped in extremely difficult or time-
consuming situations, such as under large amounts of debris or behind walls.
 Fourth Stage. Remove the dead.

B-7. Proper Handling of Casualties

a. You may have saved the casualty's life through the application of appropriate first aid measures.
However, his life can be lost through rough handling or careless transportation procedures. Before you
attempt to move the casualty--

 Evaluate the type and extent of his injury.

 Ensure that dressings over wounds are adequately reinforced.
 Ensure that fractured bones are properly immobilized and supported to prevent them from
cutting through muscle, blood vessels, and skin. Based upon your evaluation of the type and
extent of the casualty's injury and your knowledge of the various manual carries, you must
select the best possible method of manual transportation. If the casualty is conscious, tell him
how he is to be transported. This will help allay his fear of movement and gain his cooperation
and confidence.

b. Buddy aid for chemical agent casualties includes those actions required to prevent an incapacitated
casualty from receiving additional injury from the effects of chemical hazards. If a casualty is physically
unable to decontaminate himself or administer the proper chemical agent antidote, the casualty's buddy
assists him and assumes responsibility for his care. Buddy aid includes--

 Administering the proper chemical agent antidote.

 Decontaminating the incapacitated casualty's exposed skin.
 Ensuring that his protective ensemble remains correctly emplaced.
 Maintaining respiration.
 Controlling bleeding.
 Providing other standard first aid measures.
 Transporting the casualty out of the contaminated area.

B-8. Transportation of Casualties

a. Transportation of the sick and wounded is the responsibility of medical personnel who have been
provided special training and equipment. Therefore, unless a good reason for you to transport a casualty
arises, wait for some means of medical evacuation to be provided. When the situation is urgent and you
are unable to obtain medical assistance or know that no medical evacuation facilities are available, you
will have to transport the casualty. For this reason, you must know how to transport him without
increasing the seriousness of his condition.

b. Transporting a casualty by litter (FM 8-35) is safer and more comfortable for him than by manual
means; it is also easier for you. Manual transportation, however, may be the only feasible method
because of the terrain or the combat situation; or it may be necessary to save a life. In these situations,
the casualty should be transferred to a litter as soon as one can be made available or improvised.

B-9. Manual Carries (081-831-1040 and 081-831-1041)

Casualties carried by manual means must be carefully and correctly handled, otherwise their injuries
may become more serious or possibly fatal. Situation permitting, evacuation or transport of a casualty
should be organized and unhurried. Each movement should be performed as deliberately and gently as
possible. Casualties should not be moved before the type and extent of injuries are evaluated and the
required emergency medical treatment is given. The exception to this occurs when the situation dictates
immediate movement for safety purposes (for example, it may be necessary to remove a casualty from
a burning vehicle); that is, the situation dictates that the urgency of casualty movement outweighs the
need to administer emergency medical treatment. Manual carries are tiring for the bearer(s) and involve
the risk of increasing the severity of the casualty's injury. In some instances, however, they are essential
to save the casualty's life. Although manual carries are accomplished by one or two bearers, the two-
man carries are used whenever possible. They provide more comfort to the casualty, are less likely to
aggravate his injuries, and are also less tiring for the bearers, thus enabling them to carry him farther.
The distance a casualty can be carried depends on many factors, such as--

 Strength and endurance of the bearer(s).

 Weight of the casualty.
 Nature of the casualty's injury.
 Obstacles encountered during transport.

a. One-man Carries (081-831-1040).

(1) Fireman's carry (081-831-1040). The fireman's carry (Figure B-1) is one of the easiest ways
for one person to carry another. After an unconscious or disabled casualty has been properly
positioned, he is raised from the ground. An alternate method for raising him from the ground is
illustrated (Figure B-1 I). However, it should be used only when the bearer believes it to be
safer for the casualty because of the location of his wounds. When the alternate method is
used, take care to prevent the casualty's head from snapping back and causing a neck injury.
The steps for raising a casualty from the ground for the fireman's carry are also used in other
one-man carries.
Figure B-1 Fireman carry.

(2) Support carry (081-831-1040). In the support carry (Figure B-2), the casualty must be able to
walk or at least hop on one leg, using the bearer as a crutch. This carry can be used to assist
him as far as he is able to walk or hop.

(3) Arms carry (081-831-1040). The arms carry is used when the casualty is unable to walk.
This carry (Figure B-3) is useful when carrying a casualty for a short distance and when placing
him on a litter.

(4) Saddleback carry (081-831-1040). Only a conscious casualty can be transported by the

saddleback carry (Figure B-4), because he must be able to hold onto the bearer's neck.
(5) Pack-strap carry (081-831-1040). This carry is used when only a moderate distance will be
traveled. In this carry (Figure B-5), the casualty's weight rests high on the bearer's back. To
eliminate the possibility of injury to the casualty's arms, the bearer must hold the casualty's arms
in a palms-down position.
(6) Pistol-belt carry (081-831-1040). The pistol-belt carry (Figure B-6) is the best one-man carry
when the distance to be traveled is long. The casualty is securely supported by a belt upon the
shoulders of the bearer. The hands of both the bearer and the casualty are left free for carrying
a weapon or equipment, climbing banks, or surmounting obstacles. With his hands free and the
casualty secured in place, the bearer is also able to creep through shrubs and under low
hanging branches.
 (7) Pistol-belt drag (081-831-1040). The pistol-belt drag (Figure B-7) and other drags are
generally used for short distances. In this drag the casualty is on his back. The pistol-belt drag is
useful in combat. The bearer and the casualty can remain closer to the ground in this drag than
in any other.

Adjust/Extend Two Pistol Belts (Or Three, If Necessary) Or Similar Objects To Their Full Length And
Join Them Together To Make One Loop. Roll The Casualty Onto His Back. Pass The Loop Over The
Casualty's Head And Position It Across His Chest And Under His Armpits; Then Cross The Remaining
Portion Of The Loop, Thus Forming A Figure Eight. Keep Tension On The Belts So They Do Not
Become Unhooked. Lie On Your Side Facing The Casualty, Resting On Your Elbow. Slip The Loop
Over Your Arm And Shoulder That Your Leaning On And Turn Away From The Casualty Onto Your
Abdomen, Thus Enabling You To Drag The Casualty As You Crawl.

(8) Neck drag (081-831-1040). The neck drag (Figure B-8) is useful in combat because the
bearer can transport the casualty when he creeps behind a low wall or shrubbery, under a
vehicle, or through a culvert. This drag is used only if the casualty does not have a broken/
fractured arm. In this drag the casualty is on his back. If the casualty is unconscious, protect his
head from the ground.
(9) Cradle drop drag (081-831-1040). The cradle drop drag (Figure B-9) is effective in moving a
casualty up or down steps. In this drag the casualty is lying down.
b. Two-man Carries (081-831-1041).

(1) Two-man support carry (081-831-1041). The two-man support carry (Figure B-10) can be
used in transporting both conscious or unconscious casualties. If the casualty is taller than the
bearers it may be necessary for the bearers to lift the casualty's legs and let them rest on their
forearms.
Figure B-10 Two-man Support Carry ( Illustration A and B)

(2) Two-man arms carry (081-831-1041). The two-man arms carry (Figure B-11) is useful in
carrying a casualty for a moderate distance. It is also useful for placing him on a litter. To
lessen fatigue, the bearers should carry him high and as close to their chests as possible. In
extreme emergencies when there is no time to obtain a board, this manual carry is the safest
one for transporting a casualty with a back/neck injury. Use two additional bearers to keep his
head and legs in alignment with his body.
 (3) Two-man fore-and-aft carry (081-831-1041). The fore-and-aft carry (Figure B-12) is a most
useful two-man carry for transporting a casualty for a long distance. The taller of the two
bearers should position himself at the casualty's head. By altering this carry so that both
bearers face the casualty, it is also useful for placing him on a litter.
  
 
 be used to move the casualty a moderate or long distance.

 Fireman’s Carry

Fireman’s Carry
 

This carry must NEVER be used to move a person who has an injured neck, back and pelvis.

TWO-MAN CARRY

 Chair as a litter
 Chair as a litter

The chair carry can be used for a conscious or unconscious casualty but not for suspected head/spinal
injuries. For protection, secure the casualty’s hands across his or her chest and, if the casualty is
unconscious. secure the person to the chair.

 Four Hand Seat

 Four Hand Seat

This is also a good carry for a conscious casualty who can use hands and arms for support.

DRAGS
  Shoulder Drag  

This carry is used to drag a casualty who is either lying on their back or in a sitting position. Ease your
hands under the casualty’s shoulders and grasp the clothing on each side, supporting the head between
your forearms. Drag the casualty backward only as far as necessary for his/her safety. But be careful,
make sure not to choke the casualties when pulling on their clothing.

 Blanket Drag

Blanket Drag

An alternate method to the shoulder drag where the rescuer can use a blanket to support and pull the
casualty.

 
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 be used to move the casualty a moderate or long distance.

 Fireman’s Carry

Fireman’s Carry
 

This carry must NEVER be used to move a person who has an injured neck, back and pelvis.

TWO-MAN CARRY

 Chair as a litter
 Chair as a litter

The chair carry can be used for a conscious or unconscious casualty but not for suspected head/spinal
injuries. For protection, secure the casualty’s hands across his or her chest and, if the casualty is
unconscious. secure the person to the chair.

 Four Hand Seat

 Four Hand Seat

This is also a good carry for a conscious casualty who can use hands and arms for support.

DRAGS
  Shoulder Drag  

This carry is used to drag a casualty who is either lying on their back or in a sitting position. Ease your
hands under the casualty’s shoulders and grasp the clothing on each side, supporting the head between
your forearms. Drag the casualty backward only as far as necessary for his/her safety. But be careful,
make sure not to choke the casualties when pulling on their clothing.

 Blanket Drag

Blanket Drag

An alternate method to the shoulder drag where the rescuer can use a blanket to support and pull the
casualty.

 
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Medicine for the Outdoors: The Essential Guide to

First Aid and Medical Emergency, 5th Edition
TRANSPORT OF THE INJURED VICTIM
1. Never move a victim unless you know where you are going. If you are lost
and caring for an injured victim (or yourself), prepare a shelter. Try to
position yourself so that visual distress signals can be fashioned in an open
field, in the snow, or near a visible riverbank. Keep the victim covered and
warm. Assume that the victim is frightened and needs frequent reassurance.
If he cannot walk, you must attend to his bodily functions. A urinal can be
constructed from a wide-mouthed water bottle. Defecation is more
complicated, but may be assisted by cutting a hole in a blanket or sleeping
pad placed over a small pit dug in the ground.

2. Unless you are in danger, never leave a victim who is unconscious or

confused.

3. If possible, send someone for help and wait with the victim, rather than
perform an exhausting and time-consuming solo or duo extrication. If
someone is to be sent for help, choose a strong traveler and provide him
with a written request that details your situation (number of victims,
injuries, need for supplies, specific evacuation method required). While you
certainly don’t want to underestimate the seriousness of the situation, don’t
request a helicopter evacuation for someone with a sprained ankle who can
easily be carried out in a litter. Anyone sent to obtain assistance should
contact the closest law enforcement agency, which will seek the appropriate
rescue agency.

4. Conserve your strength. Don’t create additional victims with heroic

attempts at communication or feats of strength and exertion.

5. Attempt to transport a victim only if waiting for a rescue party will be of

greater risk than immediate movement, if there are sufficient helpers to
carry the victim (as a general rule, it takes six to eight adults to carry one
injured victim), and if the distance is reasonable (under 5 miles, or 8 km). A
victim who is carried on an improvised stretcher over difficult terrain usually
gets a rough ride. Always test your carrying system on a noninjured person
before you use it on the victim.

LIFTING AND MOVING TECHNIQUES

Straight Lift

If a person is seriously injured, profoundly weak, or unconscious, he should

be lifted so that he remains motionless and with his spine in as straight an
alignment as possible. This can be accomplished by five rescuers. The first
kneels at the head, controls the victim’s head and neck, and calls out
commands. The other four rescuers kneel at the victim’s sides, one at chest
level and one at hip level on one side, and the others at lower back level and
leg level on the opposite side (Figure 232). In this way, they can slide their
hands under the victim in a staggered fashion to provide a continuous chain
of support. If necessary, the rescuer closest to the legs can free a hand to
position a pad, backboard, or litter underneath the victim. The rescuers
should lift the victim straight up into the air, taking care not to
injure their backs.

Figure 232 Proper hand positioning for straight lift.

Logrolling the Victim (See Figure 25)

The best way to carry and immobilize a person who may have an injured
spine is to use a scoop stretcher, or to slide a backboard underneath the
victim. However, when these are not available and a spine-injured person
must be turned, logrolling is the best alternative. It is also the preferred
method to turn a victim on his side in order to slide a pad, board, or litter
underneath him.

1. The first rescuer approaches the victim from the head, and keeps the
head and shoulders in a fixed position (no neck movement).

2. The second rescuer extends the victim’s arm (on the side over which the
victim is to be rolled) above the victim’s head. The first rescuer takes this
arm and uses it to help support the head in proper position. If the arm is
injured, it is maintained at the victim’s side.
3. All rescuers work together to roll the victim, without moving his neck.

CARRIES AND LITTERS

The method of evacuation used to transport a victim will depend on the

degree of disablement and what is available to the rescuer(s). To conserve
the energy of all party members, victims of minor injuries should travel
under their own power as much as possible, but should never travel
unattended. One healthy and strong person should accompany anyone who
must leave the group for medical reasons.

Carries

If the victim has suffered an injury that does not allow him to walk out,
mechanical transport must be improvised. A single person who cannot walk
but who does not need to be on a litter (one with, for example, a broken
ankle, mild exhaustion, or acute mountain sickness) may be carried on the
back of a strong rescuer using a rope seat. This is fashioned by passing a
long 1 in (2.5 cm) rope or strap across the victim’s back and under his arms,
then crossing the rope in front of his chest. The victim is loaded piggyback
onto the rescuer’s back, and the rope ends are passed forward over the
shoulders of the rescuer, under his arms, and around to the rescuer’s back,
then between and through the victim’s legs from the front, and around the
outside of the victim’s legs just under the buttocks, to be tied snugly in front
of the rescuer’s waist (Figure 233). Such a rope seat is far preferable to a
standard fireman’s carry, which is very fatiguing (Figure 234). A blanket
drag (Figure 235) is only good for very short distances, such as to pull a
person quickly away from an immediate hazard.
Figure 233 Fashioning a rope (webbing) seat.

Figure 234 Fireman’s carry.

Figure 235 Blanket drag.

Other simple ways to carry a victim include the four-hand seat, backpack
carry, ski pole or tree limb backpack carry, and coiled rope seat. In the first
method, two rescuers interlock hands. Each rescuer first grasps his right
wrist with his left hand. Holding the palms down, each rescuer then firmly
grasps the left wrist or forearm of the other rescuer with his right hand,
interlocking all four hands (Figure 236). The victim sits on the four-hand
seat. In the second method, leg holes can be cut into a large backpack, so
that a victim can sit in it like a small child would in a baby carrier. In the
third method, two rescuers with sturdy backpacks stand side by side. Pack
straps are looped down from each pack, and ski poles or tree limbs are slung
across through the loops, or the poles are placed to rest on the padded hip
belts. The poles should be padded so that the victim can sit on the rigid
seat, steadying himself by draping his arms around the shoulders of his
rescuers (Figure 237). The split-coil rope seat is created by coiling a rope,
then fixing the coil at one segment. The coil’s loops are split and used to
position the victim on the rescuer’s back (Figure 238). A two-rescuer split-
coil technique is also useful (Figure 239).
Figure 236 A, Overlapping hands to create a four-hand seat. B, Carrying the
victim.

Figure 237 Fashioning a ski pole seat. A, The poles are slung between rescuers
wearing backpacks. B, A victim can sit comfortably on the padded ski poles.
Figure 238 Creating a coiled rope seat. A, The rope is coiled and the loops
secured. B, The loops of the coil are divided into equal sections at the point of
fixation. C, The victim can step through the split loops. D, Thus, a single
rescuer can carry the victim.
Figure 239 Two-rescuer split-coil rope seat.

Litters

The safest anatomical position for an injured victim (from a transport

perspective) is supine with his back straight, eyes forward, and arms and
legs straight with his hands at his sides. If the victim might vomit or is
unconscious, he should be on his side, cushioned to protect against undue
motion and to ensure an open airway.

If a specialized litter or stretcher (such as a Stokes basket or split scoop

frame) is not available, an improvised litter can be constructed from a
blanket or sturdy drop cloth and two 6 to 7 ft (1.8 to 2.1 m) poles or sturdy
tree limbs (saplings). Separate the poles by slightly more than the width
necessary to carry the victim. Fold the blanket over one pole, then fold the
edges over the other pole sequentially and back again over the first pole
(Figure 240). Secure the outside blanket flap with safety pins or stitches of
cord. Test it to be sure that it can support the victim. Carry the victim so
that his body secures the outside (free) blanket flap. Be sure to immobilize
the victim on the litter, and cushion his head and neck.

Figure 240 Blanket-pole litter.

Litters resembling ladders can be fashioned from tree limbs or ski poles
fastened with twine, rope, clothing, or pack straps. Two backpack frames
can be fastened together with tape or rope (Figure 241) to form a ladder-like
platform for a sleeping bag or pads and blankets. A “parka litter” can be
created by running two skis or long tree limbs through zipped jackets that
are aligned bottom-to-bottom (Figure 242).

Figure 241 Construction of a backpack frame litter. Pads or a sleeping bag are

placed on the litter.
Figure 242 Parka litter.

A rope stretcher is constructed by stretching a 150 to 200 ft (46 to 61 m)

rope on the ground and determining its midpoint. At the midpoint, fold the
rope back on itself. Measure 3 ft (91 cm) from the bend, and fold each half
of the rope back again to the outside. This creates the central “rungs” of a
“ladder” that will be 3 ft wide. Repeat the process of folding the rope back
on itself in 3 ft segments, moving away from the central rungs in each
direction and laying out a series of evenly spaced parallel loops. About 16 or
18 loops (rungs) should create a ladder approximately the same length as
the victim. Take the two remaining long ends of the rope and lay them
perpendicular to the rungs, alongside the bends in the rope (Figure 243).
Use the long ends to secure the loops together (completing the long sides of
the ladder) by tying a clove hitch (see Figure 259) or other secure knot onto
each consecutive bend in the rope 2 to 3 in (5 to 7.5 cm) inside the bend, so
that a small loop remains to the outside of the knot. Each pair of knots
should be separated by 3 to 4 in (7.5 to 10 cm). After all the knots are tied,
the rope ends are threaded through the small outside loops as the remaining
lengths are circled around the outside of the stretcher and finally tied off.

Figure 243 Making a rope stretcher. A, Having laid a series of parallel loops,

lay the lengthwise segments perpendicularly alongside. B, Use a clove hitch to
secure the loop ends. C, The remaining long ends of the rope are passed
through the outside loops to form the perimeter of the stretcher, and are tied
off to complete the process.

A mummy litter (also called a daisy chain or cocoon wrap) can be

constructed of a long climbing rope, large tarp, sleeping pads, blankets or a
sleeping bag, and stiffeners (skis, poles, tree limbs, or the like). The rope is
laid out with even U-shaped loops (Figure 244) that are roughly twice the
victim’s width. Tie a small loop at the foot end of the rope. Lay a tarp on the
rope. On the tarp, lay down foam pads, then lengthwise stiffening rods, then
another layer of pads. Lay the victim on the pads, and cover with the
sleeping bag or blankets. Pull the sides of the tarp up to wrap the victim. To
secure him, bring the first untied loop above the tied end (foot) loop through
the tied loop, and pull it toward the center. Moving toward the head, feed
the next loop through the preceding loop, and so on until the armpits are
reached. At this point, bring a loop up over one shoulder and tie the rope off
in front of the victim after bringing the rope end over the opposite shoulder.
Figure 244 Mummy litter. A, Lay out the rope in even loops. B, Lay blankets or
tarps over the loops, and then long, rigid objects for stability. C, Place a
sleeping bag or blanket in the center to hold the victim. D, Pass the first nontied
loop through the tied loop and work your way to the top. Bring the finishing
loop and rope end over the shoulders, and tie off.

Test any litter on an uninjured person before trusting it to bear the weight of
the victim. Be certain to fasten the victim securely into the stretcher or
litter, so that he doesn’t fall out. Pad all injuries, and the head and neck in
particular, to make the victim as comfortable as possible. Positioning on a
litter is very important. In general, keep the injury uphill, to keep extra
weight (pressure) and jostling from causing pain. If the chest is injured,
keep the victim lying on his side with the wounded side (lung) down, to
allow the good lung to expand more fully. If the victim has altered
consciousness, is nauseated, or is vomiting, he should be kept on his side, to
protect the airway (see page 24). If the victim has suffered a face, head, or
neck injury, he should be transported with his head slightly elevated. Victims
with shock (see page 60), bleeding, or hypothermia (see page 305) should
be carried with the head down and feet elevated. Victims with chest pain
and/or difficulty breathing, which might indicate a heart attack or heart
failure (see page 47), should be carried with the upper body elevated.

All victims should be covered above and below with blankets, clothing,
sleeping bags, or whatever else is available for warmth. Handle all suspected
hypothermics gently. A victim secured to a stretcher should never be left
unattended. Constantly reassure the victim. If the terrain is steep, keep his
feet pointed downhill. Litter transport is exhausting for the rescuers and
should not be entertained if the distance to be covered is more than a few
miles.

If possible, position at least one rescuer at the head of the victim, one at
each shoulder, one at each hip, and one at the legs. This allows a litter to be
carried and facilitates a quick action to turn the victim, should that be
necessary. A leader should call out all activities of the team.

HELICOPTERS

Most helicopters used for medical evacuation can safely land at altitudes of
up to 10,000 ft (3,050 m) and are limited by visibility, landing space, and
weather conditions. Rescue helicopters may operate under visual flight rules
(“VFR”), which means that flight conditions must be free of clouds and where
airspeed can be slow enough for the pilot to see far enough to avoid a
collision. Larger military and search and rescue helicopters can fly under
instrument flight rules (“IFR”), using special navigational instruments, and
can land at higher altitudes.

When calling for a helicopter, provide the following information: number of

victims and their weight, injuries, and level of consciousness; reason why
you need a helicopter; location of the landing zone; and the current and
expected weather conditions (temperature, visibility, distance [“ceiling”]
from ground to clouds, and wind speed/direction). People on the ground
should be aware of the limitations of maneuverability, and should obey
certain rules when involved with a helicopter rescue:

1. Prepare and brightly mark a proper landing site. The ideal location is on
level ground (bare rock is best; snow is worst) with no more than 10
degrees of incline and access from all sides. If possible, choose a site where
the helicopter will be able to drop off during takeoff, rather than having to
climb up. It is also desirable to have a helicopter take off or land into the
wind, to increase lift. Ideally, there will be 360-degree access so that the
helicopter can take off in any direction, depending on wind conditions. Clear
an area 100 ft (31 m) long by 100 ft wide of all debris that could interfere
with landing or be scattered by gusts from the propellers. Although the
absolute minimum ground dimensions for a “safety square” can, under ideal
weather and visibility conditions, be somewhat less than this, you should
clear the full area (or even up to 100 ft (31 m) by 300 ft (93 m), as a
helicopter can rarely take off or land strictly vertically, particularly in the
thinner air of high altitude. A smoky fire or smoke signal should be placed
near the landing site so that the pilot can judge the wind (pilots prefer
takeoffs and landings to be directed into the wind). If this is not possible,
stand away from the landing site where the pilot can see you, and hold up
an improvised wind flag (such as streamers), or position yourself with the
wind behind your back, and point with both arms at the landing site. At
night, if you have lights, shine them on objects that will alert the pilot to
unseen danger (such as the poles of power lines). If there is a danger at the
last minute before landing, signal “do not land” to the helicopter pilot by
lifting your arms from a horizontal (to-the-side) outstretch to straight
overhead several times. (Remember that waving your arms and hands
frantically is the universal “wave-off” instruction!) If the landing area is on
snow, place some large markers, such as backpacks, near the landing spot
to offer the pilot some depth perception. At night, create a landing area at
least half again as large as during the daytime, and position lights or small
fires in the corners, pointing down at the ground rather than up into the air.
Never shine a flashlight directly at a helicopter, to avoid blinding the crew. If
fires are used, remember that the helicopter may scatter embers, so watch
carefully for unintended fire spread. Minimize the number of people
approaching the helicopter.
2. To summarize hand signals for guiding a helicopter pilot into a landing,
stand with your back to the wind and extend both arms directly toward the
landing area, which signifies where to land and that the wind is at your back.
As the helicopter hovers over the proper landing site, extend your arms to
the sides with clenched fists, which signifies to the pilot to hold the hover. As
the helicopter begins to touch the ground, move your arms down at a 45-
degree angle to the ground with hitchhiker thumbs pointing downward,
signifying to the pilot to hold the ground position. When you want the rotors
to be turned off, slice your hand across your neck with the palm pointed
down.

3. Unless otherwise instructed, stay at least 150 ft (46 m) from a helicopter

with rotors spinning. Look away as the ship lands, so as not to be struck in
the face or eyes by flying debris. Protect the victim. Secure all loose objects
or clear them from the landing area. Coil and secure all ropes. Because of
the strong gusts from the approaching helicopter (up to 100 mph, or 161 km
per hour), do not stand near the edge of a cliff! Do not stand in the landing
zone if on snow, in case the helicopter settles.

4. Always approach or leave a helicopter at a 30- to 45-degree angle from

the front, in sight of the pilot and crew (Figure 245). Never approach the
helicopter from ground higher than the landing spot, to avoid walking into a
rotor. Stay away from the tail rotor, because it is nearly invisible when
rotating. All loading and unloading of a helicopter should occur on the
downhill side of the aircraft, to avoid striking a rotor.

5. Keep your head down! You may not perceive that the rotor blade is
dipping (up to 4 ft, or 1.2 m, from the center attachment) until it chops your
head off. Don’t hold any objects (particularly not your arms) above your
head. Protect your eyes from dust kicked up by the rotor wash.

6. Do not smoke a cigarette near a helicopter.

7. Follow the pilot’s and flight crew’s instructions. Do not approach, enter,
leave, or load a helicopter until he gives the command. Establish eye contact
with the pilot and obey his signals.

8. Do not stand under or anywhere near a helicopter during takeoff or

landing. Everyone near the landing site should stay at a safe distance in a
single group, clearly visible to the pilot. At night, carry a light or wear a
reflective object or clothing.
9. If a cable or rope is lowered, allow it to touch the ground before you
handle it, to avoid a shock from static electricity. Never tie the rope or cable
to an immovable object on the ground; this could cause a crash.

10. If a rescue device (e.g., litter) is being used, put the victim into the
rescue device and take care to keep the hoist cable clear of looping around
anyone in the area. Be certain that the victim is properly strapped into the
rescue device before anyone signals to haul up the cable.

11. All people should wear hard hats and eye protection, if available. Keep
jackets zipped. Carry all packs, rather than wear them on your back.
Figure 245 Approach zones around a helicopter. A, It is best to approach from
the front. B, Don’t walk uphill into the helicopter rotor blades.

Victim Carries: When one or more rescuer is able to lift the victim

and carry them to a location of safety.

Victim Drags: The movement of a victim by lifting part of their

body as the other part drags — often used when a carry isn't
possible or practical.

Regardless of whether you carry or drag a victim to safety, you

must remember to keep your own safety a high priority. It doesn't
sound heroic to say, but it does no good for anyone if you injure
yourself and become part of the problem rather than the solution.

Moving a victim is harder than most realize. If the victim is

conscious, pain from their injuries may cause them to shift their
weight around while you're moving them, creating a scenario
where your back or joints are forced into unnatural or unsafe
positions — leading to a strong likelihood of rescuer injury. The
victim may be vocal, crying or shouting, distracting you from your
task, which also lends itself to injury.

If the victim is unconscious this creates a deadweight situation.

They're unable to assist you in any way, tell you if you're hurting
them, or causing greater injury by your movements. Also, the
mental demands of moving an unconscious victim already
increase the rescuer's anxiety out of concern.

The techniques discussed in the article are tried-and-true first

responder techniques that are applicable to any survival situation.
The way you choose to relocate a victim will depend on several
factors and exact steps may vary depending on victim injury:

 How many victims are in need of rescue?

 How many rescuers are available?
 What are the capabilities and conditions of the rescuers?
 What is the size and condition of the victim(s)?
 What is the safety and stability of the environment?
One-Person Carries

You may be the only person available to help, or perhaps your

team has already split up to render aid to multiple victims. Either
way, there are times when you'll be forced to move someone by
yourself. Carries conducted by a single rescuer can be extremely
taxing on the rescuer. Adrenaline will work both for and against
you. You may feel a sudden burst of energy and strength, but will
lose it just as quickly. The body will compensate by relying on large
muscle groups, such as the back, as this could result in rescuer
injury. One-person carries should only be performed with the
confidence that you won't cause injury to yourself or further injury
to the victim.

One-Person Walk Assist

In mass-casualty training, we refer to people who can self-

extricate with little or no assistance as walking wounded. If your
victim is able to walk with only minor help from you, let them. The
one-person walk assist offers the least chance for injury to both
rescuer and victim.

Steps:

1. Place victim's arm around your neck and hold their wrist:
2. Place your arm nearest to them around their waist and walk
with them to safety:

Above: Although the one-person walk assist is one of the easiest

methods of helping to carry an injured person, never attempt to move
anyone you think may have neck or spinal injuries without proper
training.

Firefighter Carry

Made famous by the occupation, this type of carry should only be

conducted by a very strong rescuer and a smaller victim. It'll
require good lifting techniques as well as good core and lower
body strength. Traversing uneven ground can be difficult because,
with the victim in place, the rescuer becomes very top heavy. The
firefighter carry can be used on either a conscious or unconscious
victim.

1. With victim lying down, hook your elbows under their armpits:

2. Raise them to a standing position:

3. Place your right leg between the victim's legs:

4. Grab the victim's right hand with your left:

5. Squat and wrap your right arm around the victim's right knee:
6. Stand and raise the victim's right thigh over your right shoulder

Pack Strap Carry

The pack strap carry has been utilized by the military for decades.
It's a quick, down-and-dirty way to move a victim quickly. If not
done correctly, this carry can be extremely uncomfortable for the
victim. This is typically used on a conscious victim. For an
unconscious victim, it can be done, but you may require assistance
getting them into the position for you to safely follow the steps.

1. Facing away from the victim, place their arms over your
shoulders:

2. Cross the victim's arms grasping the opposite wrist and pull
close to your chest:
3. Squat, lean slightly forward, and drive your hips into the victim
as you stand:
Two-Person Carries

The most safe and efficient way to carry a victim is by two

rescuers. The rescuers can share the weight, help each other
watch for hazards, and work together efficiently without crowding
too many people around the victim. It also reduces rescuer fatigue,
which allows the rescuers to cover a greater distance or to return
to aid more victims.

Two-Person Extremity Carry

This is a common carry that's used by first responders and the

military. It's easily performed, but best suited for moving a victim
over even terrain, such as along a paved path or within a building.
Both conscious and unconscious victims can be carried in this
manner.

Steps:

1. Help the victim to a seated position:

2. First rescuer kneels behind the victim, reaches under their arms,
and grabs their wrists

3. Second rescuer backs between the victim's legs, squats down,

and grabs behind the knees:

4. Stand at the command of the rescuer at the head, focusing on

using your legs rather than your back:
Chair Carry

One universal truth when speaking with anyone who prepares for
catastrophe is that you use what's available to you. Moving victims
is no different. A chair, for example, makes the transport of a
victim significantly easier on the rescuers. This method is easier to
perform with a conscious victim, but can be done with an
unconscious victim as long as due care is taken.

Steps:

1. Place victim in a sturdy chair:

2. First rescuer stands behind, grabs the back of the chair, and
leans it back on its hind legs:

3. Second rescuer backs to the chair, squats down, and grabs the
front legs of the chair:

4. Stand at the command of the rescuer at the head:

 

Two-Handed Seat Carry

The two-handed seat carry should only be conducted on conscious
victims. Rescuers will utilize their arms to create a seat and the
victim will need to be able to hold on for balance and stability.

1. Each rescuer should kneel on either side of the seated victim:

2. Link arms behind the victim's back:

3. Place your free arms under the victim's knees and link arms:

4. Place victim's arms around the shoulders of rescuers and stand

together:
Drags

A victim drag is typically employed when victim removal is time-

critical, or when the size of the victim prevents a safe carry. A
coordinated carry is always the safer option, but under certain
circumstances, a “grab ‘n' go” is necessary, particularly if the victim
is unconscious. Oftentimes, though, when victims need to be
relocated the terrain is uneven and treacherous, creating a
dangerous scenario for both the rescuer and the victim. However,
when a rapid extraction is necessary, a drag may be the only
option. If at all possible, debris should be cleared from the path of
the drag to reduce the chance for injury to the rescuer and further
injury to the victim.
Blanket Drag
Along the same line of thought as the chair carry, utilize what you
have available to you when performing a victim drag. The blanket
drag can be performed with a blanket, or a sheet, curtains, towel,
tarp, or anything else that'll accomplish the same goal.

Steps:

1. Tuck the blanket under one side of the victim:

2. Roll the victim onto the blanket:

 
3. Adjust the blanket so the victim is centered:

4. Grab the blanket by the end near the victim's head and drag to
safety:
 

Shoulder Drag
The shoulder drag is another emergent maneuver for when a
person needs to be moved quickly. This drag is difficult to perform
over long distances as it's physically taxing on the rescuer.

Steps:

1. Place victim in a seated position:

2. Squat behind the victim and reach under their arms grasping
your own wrist:
3. Stand, lean back, and walk backward dragging the victim to
safety:

Feet Drag

The feet drag is a last resort. Moving a victim in this manner will
most certainly be uncomfortable for the victim and will likely cause
greater injury. It's a “life over limb” technique. This can really be
accomplished only if the victim is unconscious because of the pain
of dragging their torso and head along the ground.

Steps:
 1. Squat at the feet of the victim and grasp their ankles:

2. Stand, lean back, and drag:

LESSON 16
TRANSPORT A CASUALTY
(TASK 081-831-1046)

TASK:

Identify the appropriate one-man carry and/or how to perform the carry.

CONDITIONS:
Given multiple-choice examination items pertaining to evacuation.

STANDARD:

Score 70 or more points on a 100-point comprehensive examination.

REFERENCES:

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

NOTE: Some of the task titles and information have changed and are not reflected
in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center,
Common Core Task internet site
at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task
information.

16-1. INTRODUCTION

After evaluating the casualty's illness or injury and administering first aid, you may
need to decide the most effective means of transporting a casualty. Casualties moved
by manual carries must be carefully and correctly handled; otherwise, moving the
casualty could result in additional injury. Manual carries are often used to transport
casualties in tactical situations. Your choice of which type of carry to use depends
upon the seriousness of the illness or injury, the weight of the casualty, the strength of
the carrier (s)), and the distance to be traveled. Using a two-man carry benefits the
casualty and the bearers by spreading the load. Improvised litters are the preferred
method when the distance may be too far for manual carries or the casualty has an
injury that may be aggravated by manual transportation. These litters are for
emergency measures and must be replaced by a standard litter at the first opportunity.

SECTION I. ONE-MAN CARRIES

16-2. CHOOSE THE APPROPRIATE METHOD TO MOVE A CASUALTY

ON THE BATTLEFIELD

If you need to move (evacuate) a casualty to an aid station or collection point, you
must decide which evacuation method is appropriate. The following are general rules.
(The rules are listed in order of most likely to be used to less likely to be used in a
frontline combat situation.)

CAUTION: Do not transport a casualty with a suspected fracture of the neck

 or back unless a life-threatening hazard is in the immediate area. Wait until
medical personnel arrive.

If no other help is available, use an appropriate one-man carry to move the casualty.

If a litter cannot be used (no time, no materials) and another person is available to
help carry the casualty, use an appropriate two-man manual carry to move the
casualty.

If a standard litter is not available and if the time, materials, and litter bearers are
available, construct and use an improvised litter. A door, ladder, cot, bench, chair, or
similar objects can be used as an improvised litter.

If the casualty is to be moved, use a standard litter if one can be obtained and two or
more litter bearers (including yourself, if applicable) are available. A litter allows a
casualty to be moved a greater distance than do manual carries. Also, a casualty is less
likely to aggravate existing injuries or to suffer additional injuries if a litter is used.

If possible, use a vehicle to transport the casualty.

16-3. CHOOSE AN APPROPRIATE ONE-MAN CARRY

Manual carries are tiring to the bearer. Choose an appropriate carry based upon the
casualty's condition, the nature of the casualty's injury, the military situation, the
distance to be covered, the weight of the casualty, your strength and endurance, and
obstacles that will be encountered.

The fireman's carry is usually used to quickly move an unconscious or disabled

casualty for a moderate or long distance. This carry leaves one of the bearer's arms
free to carry a rifle, move around obstacles, and so forth.

The support carry is used only with a conscious casualty who can walk or at least hop
on one leg. The carry can be used for a long distance until the casualty tires.

The arms carry is generally used to move a conscious or unconscious casualty for a

short distance.

The saddleback carry is only used for a conscious casualty who can put his arm (s))
around your neck. It is generally used to carry a casualty for a moderate or long
distance.
The pack-strap carry is generally used to carry a conscious or unconscious casualty
for a moderate distance. This carry is not used if the casualty has a broken arm.

The pistol-belt carry is generally used to carry a conscious or unconscious casualty for

a long distance. It is the preferred carry if you must use your rifle, climb banks, or
move over obstacles since the carry leaves both of your hands free.

The pistol-belt drag is generally used to move a conscious or unconscious casualty for

a short distance. This carry is primarily used when the rescuer must keep very close to
the ground, such as during combat.

The neck drag is generally used to move a conscious or unconscious casualty for a

short distance. This carry allows the rescuer to stay close to the ground, but not as
close as the pistol-belt drag. The carry can be used when moving behind a low wall,
under a vehicle, or through a culvert. The neck drag is not used if the casualty has a
broken arm.

The cradle drop drag is generally used to move a conscious or unconscious casualty

up or down steps or to quickly move a casualty from a life-threatening situation (fire,
etc.).

16-4. POSITION A CASUALTY

Some one-man carries require the casualty to be lying on his abdomen (prone
position); other carries/drags require him to be lying on his back (supine position). To
turn the casualty either to the prone or supine position, follow these steps.

Kneel at the casualty's uninjured side.

FIGURE 16-1. TURNING A CASUALTY ONTO HIS ABDOMEN

WARNING
   If you are in a chemical environment, squat--do not kneel on the
ground.

Place the casualty's arms above his head.

Cross his far ankle over the near one.

Grasp the casualty's clothing at his far shoulder and hip.

Gently pull so that the casualty rolls toward you. Continue until the casualty is on his
abdomen or back.

Place the casualty's arms at his sides and straighten his legs.

16-5. RAISE A CASUALTY TO A STANDING POSITION

Some one-man carries require that the casualty be raised to a standing position. If the
casualty is conscious, you may be able to simply assist him in standing up. If the
casualty is unconscious, however, you may need to raise him to a standing position
without his help. Usually a casualty is raised from the prone position; therefore, it may
be necessary to turn him onto his abdomen. The alternate method is used only if you
believe that this method will be safer for the casualty due to the location of his
injuries.

Regular method.

Position the casualty in a prone position.

Straddle the casualty, slip your hands under his chest, and lock your hands together.

Lift the casualty and begin walking backwards until he is on his knees.

Continue walking backwards until his legs are straight and his knees are locked.

Walk forward and bring the casualty to a standing position. Keep the casualty tilted
slightly backwards so his knees will remain locked. If his knees do not remain locked,
walk backward until they lock and then move forward until the casualty is in the
standing position.

Grasp one of the casualty's wrists and raise his arm. Use your other arm to hold the
casualty erect.
 FIGURE 16-2. RAISING A CASUALTY TO HIS FEET (REGULAR
METHOD)

Move under the casualty's arm to his front, replace his arm, and hold the casualty
around his waist.

Place your foot between the casualty's feet and spread them so that his feet are about
six to eight inches apart.

Alternate method

Position the casualty in a prone position.

Kneel on one knee at the casualty's head.

Put your hands under his armpits, down his sides, and across his back.

Rise, lifting the casualty to his knees.

CAUTION: Keep the casualty's head from snapping back and injuring his
neck.

Lower your arms, secure a hold on the casualty, and raise him to a standing position
with his knees locked.

Put your arms around the casualty's waist and tilt his body slightly backward to keep
his knees from buckling.

Place your foot between his feet and spread them so that they are about six to eight
inches apart.

FIGURE 16-3. RAISING A CASUALTY TO HIS FEET (ALTERNATE

METHOD)
16-6. PERFORM THE FIREMAN'S CARRY

Raise the casualty to a standing position.

Grasp the casualty's wrist and lift his arm over his head while continuing to support
the casualty with your other arm.

CAUTION: If the casualty has an injured arm, grasp the wrist of the
uninjured arm.

Bend at the waist and kneel, pulling the casualty over your shoulder. At the same
time, slip your arm from his waist, pass the arm between the casualty's legs, and grasp
behind the casualty's knee.

FIGURE 16-4. PERFORMING THE FIREMAN'S CARRY

Move the hand grasping the casualty's wrist to the hand at the casualty's knee.
Grasp the casualty's wrist with the hand at the casualty's knee, freeing your other
hand.

Place your free hand on your knee and slowly rise to a standing position. Use the hand
on your knee to help you rise without straining your back.

Adjust the casualty's body so his weight is distributed comfortably.

Move forward, carrying the casualty.

16-7. PERFORM THE SUPPORT CARRY

FIGURE 16-5. SUPPORT CARRY

Position the casualty in a sitting position.

Bend down at the casualty's side so that you are facing in the same direction as the
casualty.

CAUTION: If the casualty has an injured leg, position yourself so that the
injured leg is next to you.

Bring the casualty's near arm over your shoulder and grasp his wrist with your hand
that is away from the casualty.

Put your near arm around the casualty's waist.

Stand up, helping the casualty to rise to a standing position also.

Assist the casualty to walk or hop on one leg. Adjust your walking motion as needed
to help the casualty maintain his balance.

16-8. PERFORM THE ARMS CARRY

Raise the casualty to a standing position.

Slide one of your arms under the casualty's arm, behind his back, and under his other
arm.

Move to the casualty's side, bend down, and place your other arm behind the
casualty's knees.

Lift the casualty from the ground and stand erect.

Carry the casualty high on your chest to lessen fatigue.

FIGURE 16-6. ARMS CARRY

16-9. PERFORM THE SADDLEBACK CARRY

 FIGURE 16-7. SADDLEBACK CARRY

Raise the casualty to a standing position. (Since the casualty is conscious, he may be
able to rise with assistance.)

Grasp the casualty's wrist and lift his arm over his head while continuing to support
the casualty with your other arm.

Turn so that your back is to his front and bring his arm over your shoulder. Support
the casualty's waist with your other arm, if needed.

Have the casualty put his other arm around your neck. If possible, he should grasp one
of his wrists with his other hand.

Stoop and move your arms back and around the outside of the casualty's thighs.

Bring your hands inside of his thighs to your sides, lifting the casualty's thighs.

Stand up and clasp your hands together in front of you.

Adjust the casualty's weight to make the weight distribution more comfortable and
walk forward.

16-10. PERFORM THE PACK-STRAP CARRY

 FIGURE 16-8. PERFORMING THE PACK-STRAP CARRY

Raise the casualty to a standing position.

Grasp one of the casualty's wrists and lift his arm above his head while continuing to
support the casualty's waist with your other arm.

Turn and bring the casualty's raised arm over your shoulder as you turn so that your
back is to the casualty's front. Bend your knees somewhat so that your shoulder fits
under his arm.

Release his waist, grasp his other wrist, and bring that arm over your other shoulder.

CAUTION: Hold both wrists so that his hands are in a palms down position
(palms toward your abdomen). Twisting his hands could result in injury to
the casualty's wrists, elbows, or shoulders when he is lifted and carried.

Bend forward and hoist the casualty as high on your back as possible so that his
weight is resting on your back.

Walk forward, keeping bent so that the casualty's weight is balanced on your back and
his feet are not dragging.

16-11. PERFORM THE PISTOL-BELT CARRY

Form the sling by joining two fully-extended pistol belts together to form one large
loop. If pistol belts are not available, use any material which will not break and which
will not cut or bind the casualty (one rifle strap, two cravat bandages, etc.) to make the
sling.

Position the casualty on his back.

Slip the sling under the casualty so that top part of the loop is under his lower back,
the bottom part of the loop is under his thighs, the belt buckles are centered behind the
casualty, and a loop end extends from each side.

Move the casualty's legs apart and lie between them on your back.

Thrust your arms through the loop ends. Adjust the sling so that the loop ends fit over
your shoulders.

Grasp the casualty's wrist and his trouser leg on his injured side.

Roll toward the casualty's uninjured side and onto your abdomen. (Both you and the
casualty are now in a prone position.)

Release the casualty's wrist and leg and push yourself up until you are on your knees.

Rise to a kneeling position and place your hands on your knees for support.

Rise to your feet. Lean forward to balance the casualty's weight.

 FIGURE 16-9. PERFORMING THE PISTOL-BELT CARRY

Adjust the casualty's weight to a more comfortable position, if needed, and walk
forward. Your hands are free to carry a rifle or other objects, climb obstacles, etc.

 If the casualty is unconscious and you do not have to carry anything in your
hands, you can grasp his wrists (palms down) to help balance him easier while
you are walking.
  If the casualty is conscious, have him put his arms around your neck.

16-12. PERFORM THE PISTOL-BELT DRAG

Extend two pistol belts to their full length and join them together to make one large
loop. Other materials, such as a rifle sling or two cravats, can be used if pistol belts
are not available. In some cases, three pistol belts may be needed.

Position the casualty on his back.

Slip one end of the loop across the casualty's chest, under his armpits, and under his
shoulders.

Twist the remainder of the loop to form a figure 8. Adjust the loops so that the buckles
cross in the center of the figure 8.

Lie on your side facing the casualty. You should be lying in the same direction as the
casualty. Support yourself on your elbow.

Slip the arm on which you are resting through the top loop of the figure 8 and bring
the loop over your shoulder.

Turn onto your abdomen. The sling is now across your chest and the loop is on the
shoulder away from the casualty. This far shoulder will support his weight. Having
the sling under your chest will help to keep the casualty from slipping out of the loop.

Crawl, dragging the casualty with you.

 FIGURE 16-10. PERFORMING THE PISTOL-BELT DRAG

16-13. PERFORM THE NECK DRAG

Tie the casualty's hands together with material that will not cut his wrists, such as the
casualty's field dressing or a cravat. Do not tie the materials tight enough to interfere
with blood circulation. If the casualty is conscious, have him interlock his fingers.

Face the casualty's head and straddle his hips on your knees.

Loop the casualty's arms around your neck.

 FIGURE 16-11. NECK DRAG

Crawl forward on your hands and knees, dragging the casualty beneath you.

CAUTION: If the casualty is unconscious, keep his head from dragging on

the ground.

16-14. PERFORM THE CRADLE DROP DRAG

Position the casualty on his back.

Kneel at the casualty's head.

Slide your hands (palms up) under his shoulders and grasp the clothing under his
armpits.

Partially rise so that the casualty is pulled to a semi sitting position. Support his head
on one of your arms. If possible, bring your elbows together and use both forearms to
support the head.

Rise to a stooped position and drag the soldier backward.

CAUTION: If you are going down steps, walk down them carefully going
backward. Support the soldier's head and shoulders, letting his hips and legs
drop from step to step.
 FIGURE 16-12. PERFORMING THE CRADLE DROP DRAG

SECTION II. TWO MAN CARRIES

16-15. MOVE A CASUALTY USING THE TWO-MAN FORE-AND-AFT

CARRY

Sometimes, a litter is not available and cannot be improvised. In such cases, manual
carries may be used to evacuate the injured soldier. A two-man manual carry is
usually preferred over a one-man manual carry. The two-man fore-and-aft carry can
be used to move a conscious or unconscious casualty. It is not as tiring as other
carries; therefore, it is usually the preferred two-man carry for moving a casualty for a
long distance.
 FIGURE 16-13. TWO-MAN FORE-AND-AFT CARRY

Position the casualty on his back with his arms by his sides.

The taller of the two bearers kneels at the casualty's head and faces toward the
casualty's feet. He then slides his hands under the casualty's arms and across the
casualty's chest. Then he locks his hands together over the casualty's chest.

The second bearer spreads the casualty's legs and kneels between the casualty's legs
with his back to the casualty's head. He then reaches down and places his hands under
the casualty's knees.

Both bearers rise together and lift the casualty.

Bearers walk forward with the casualty.

Modified Two-Man Fore-and-Aft Carry (for placing casualty on litter).

Bearer #1 kneels behind the casualty's head and slips his arms under the casualty's
arms.

Bearer #2 spreads the casualty's legs apart and squats or kneels between the casualty's
legs while facing Bearer #1.

Both bearers rise in unison upon the leader's command.

Bearers move the casualty over the litter.

Bearers lower the casualty onto the litter in unison upon the leader's command.
 FIGURE 16-14. LIFTING A CASUALTY USING THE MODIFIED
TWO-MAN FORE-AND-AFT CARRY

16-16. MOVE A CASUALTY USING THE TWO-MAN SUPPORT CARRY

The two-man support carry can be used to transport either a conscious or an

unconscious casualty. It is especially useful if the casualty is conscious and needs
assistance walking.

FIGURE 16-15. TWO-MAN SUPPORT CARRY

Bearers kneel on each side of the casualty and face so that the casualty will also be
facing the same direction.
Each bearer takes the casualty's nearest arm, brings it around his neck, and grasps the
casualty's wrist in his outside hand.

Each bearer puts his other arm (the arm that is nearest the casualty) around the
casualty's waist.

Both bearers rise in unison, lifting the casualty. If the casualty is conscious, he can
help the bearers lift his weight and may be able to walk with assistance. The arms
around the casualty's waist should support most of the weight.

CAUTION: If the casualty is unconscious, the bearers should not release the
casualty's wrists.

Bearers walk forward with the casualty.

If the casualty is taller than the bearers, the bearers can remove their arms from
around the casualty's waist and use them to lift and support the casualty's thighs. This
will keep to the casualty's feet from dragging.

16-17. MOVE A CASUALTY USING THE TWO-MAN ARMS CARRY

The two-man arms carry can be used to move a conscious or unconscious casualty for
a moderate distance.
 FIGURE 16-16. LIFTING A CASUALTY USING THE TWO-MAN ARMS
CARRY

Position the casualty on his back and place his arms above his head.

Both bearers position themselves on the same side of the casualty--one at the
casualty's chest and one at his thighs.

Both bearers kneel on one knee.

The bearer at the casualty's chest slips one arm beneath the shoulders and the other
arm beneath his waist.

The bearer at the casualty's thighs slips one arm beneath the casualty's hips and the
other arm beneath his knees.

Both bearers shift their weight backward in unison and lift the casualty to knee level,
keeping the casualty as level as possible.

Both bearers bring the casualty's front close to their chests.

Both bearers rise to their feet in unison.

Bearers move forward carrying the casualty high on their chest. (This lessens fatigue
while transporting the casualty.)

CAUTION: More than two bearers may be required if the casualty is

heavy or if the casualty's head or legs need additional support. If a
casualty with a back or neck injury has to be moved by manual carry, a
four-man arms carry is used. A third bearer supports the casualty's
head and a fourth supports his legs. The casualty's body is kept as level
as possible and all movements are done in unison to keep the casualty's
body in alignment.

Modified Two-Man Arms Carry (for placing casualty on litter).

Two litter bearers position themselves on the same side of the casualty (opposite side
from litter) and kneel on one knee.

Bearer #1 slips his arms under the casualty's back and waist.

Bearer #2 slips his hands under the casualty's hips and knees.
Both bearers lift in unison upon command from the leader.

Bearers move the casualty over the litter or have another bearer push the litter under
the casualty.

Bearers lower the casualty onto the litter in unison upon the leader's command.

FIGURE 16-17. LIFTING A CASUALTY USING THE MODIFIED

TWO-MAN ARMS CARRY

16-18. MOVE A CASUALTY USING THE TWO-HAND SEAT CARRY

The two-hand seat carry can be used to move a conscious or unconscious casualty for
a short distance.
 FIGURE 16-18. TWO-HAND SEAT CARRY

Position the casualty on his back.

Bearers position themselves on opposite sides of the casualty's hips and kneel.

Each bearer passes one arm under the casualty's back and the other arm under the
casualty's thigh.

Bearers grasp each other's wrists securely.

Both bearers rise in unison, lifting the casualty.

Bearers move forward, carrying the casualty.

16-19. MOVE A CASUALTY USING THE FOUR-HAND SEAT CARRY

The four-hand seat carry is only used to carry a conscious casualty that can help
support himself while he is being carried. This carry is especially useful in
transporting a person with a head or foot injury for a moderate distance.

FIGURE 16-19. FOUR-HAND SEAT CARRY

Both bearers position themselves behind the casualty.

Bearers face each other. Each bearer grasps his own left wrist with his right hand, and
grasps the other bearer's right wrist with his left hand. This forms the seat for the
casualty.

Casualty stands on his own or another soldier helps the casualty to a standing position.

Both bearers lower their bodies so that the seat is about even with the casualty's knees.
Casualty sits on the bearers' forearms and places his arms around the bearers'
shoulders for balance and support.

Bearers stand erect in unison, lifting the casualty.

Bearers move forward.

SECTION III. LITTER CARRY

16-20. MAKE AN IMPROVISED POLE AND PONCHO LITTER

An improvised litter can be made using two tent poles and a poncho. Variations of this
litter include using straight tree limbs or other rigid objects for the poles. When the
casualty is placed on the litter, his weight will hold the litter together.

FIGURE 16-20. CONSTRUCTING AN IMPROVISED POLE AND PONCHO

LITTER

Open the poncho and lay it flat on the ground.

Lay two poles lengthwise across the poncho so that the poncho is divided into thirds.

Reach in and pull the hood toward you and lay it flat on the poncho. Make sure that
the draw strings are not hanging out of the hole.

Fold one outer third of the poncho over the pole.

Fold the other outer third of the poncho over its pole.

16-21. MAKE AN IMPROVISED POLE AND JACKET LITTER

An improvised litter can be made using two tent poles and two or three field jackets.
Tree limbs or other straight, rigid objects can be used instead of the poles. Heavy
shirts or other jackets can be used instead of field jackets.

FIGURE 16-21. POLE AND JACKET IMPROVISED LITTER

Close (zip or button) the jackets (or other garments).

Turn the garments inside out, but leave the sleeves inside. (Turning the garments
inside out puts buttons and zippers inside and keeps them from getting snagged on
bushes or other obstacles.)

Pass the poles through the sleeves.

16-22. MAKE AN IMPROVISED POLE AND SACK LITTER

An improvised litter can be made using two tent poles or similar rigid objects and two
empty heavy-fabric sacks such as potato sacks.
 FIGURE 16-22. POLE AND SACK IMPROVISED LITTER

Cut holes in the two corners of the closed end of each sack.

Place the sacks lengthwise so that the open ends of the sacks are facing each other.

Slide the poles or limbs through the holes.

Overlap the open ends of the sacks about three inches to provide extra strength in the
middle of the litter.

16-23. MAKE AN IMPROVISED BLANKET LITTER

An improvised litter can be made using only a blanket or similar material. The blanket
is laid on the ground. Two opposite edges of the blanket are then rolled toward the
middle. When the casualty is placed on the blanket, the rolled edges of the blanket are
used as grips. Four or more litter bearers should be used when transporting a casualty
using the blanket litter.

FIGURE 16-23. BLANKET LITTER

16-24. EVACUATE A CASUALTY BY LITTER

Care must be used when placing the casualty on the litter in order to avoid causing
additional injury to the casualty. A modified two-man arms carry or modified two-
man fore-and-aft carry is usually used to place the casualty onto the litter. Normally,
four soldiers are used to transport the litter. The litter team, however, can be
composed of more or fewer members based upon the military situation and the
distance and terrain to be covered.

General Rules
Explain the Procedure to the Casualty. If the casualty is conscious, tell him what you
are going to do. The explanation will help to calm his fears and will help you to get
his cooperation.

Walk Around the Casualty. Walk around the casualty rather than stepping over him. If
you step over the casualty, he may flinch or tighten his muscles and aggravate his
injuries. In addition, mud or other debris may fall from your boots into his eyes or
wounds.

Perform Necessary Measures Before Transporting. Make sure the casualty is

breathing properly, open wounds have been dressed and bandaged, and fractures have
been splinted before transporting the casualty.

Have One Person in Charge. One person must give the instructions to the remainder
of the team so actions will be performed in unison.

Position Litter

Position the casualty on his back with his arms at his sides. Place the litter (standard
or improvised) near and parallel to the casualty.

FIGURE 16-24. LITTER PLACED PARALLEL TO CASUALTY

Place Casualty On the Litter

Modified Two-Man Fore-and-Aft Carry (see paragraph 16-15).

Modified Two-Man Arms Carry (see paragraph 16-17).

Lift Litter

If there are four litter bearers, each bearer positions himself at one of the handles,
faces so that the casualty will be carried feet first, and kneels on one knee (the knee
nearest the litter). The leader of the litter team should position himself at the handle
nearest the casualty's right shoulder and direct the other bearers. This position allows
the leader to monitor the casualty during the evacuation.

Upon command of the leader, the four litter bearers lift the litter in unison and move
the casualty to the aid station or collection point.

(NOTE: Additional information concerning evacuation by litter can be found in Field

Manual 8-10-6, Medical Evacuation In A Theater Of Operations Tactics, Techniques,
And Procedures.)

FIGURE 16-25. LIFTING A LITTER